Drug reaction with eosinophilia and systemic symptoms without skin rash

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

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Lamotrigine induced DRESS syndrome in a child: a case report and literature review

10.21203/rs.3.rs-151612/v1 ◽

2021 ◽

Author(s):

Chien-Heng Lin ◽

Sheng-Shing Lin ◽

Syuan-Yu Hong ◽

Chieh-Ho Chen ◽

I-Ching Chou

Keyword(s):

Drug Reaction ◽

Case Report ◽

Literature Review ◽

Skin Rash ◽

Anticonvulsant Drug ◽

Dress Syndrome ◽

Life Threatening ◽

History Of ◽

History Of Epilepsy ◽

Systemic Symptoms

Abstract BackgroundLamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS).Case presentationHere, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in stable condition.ConclusionAnticonvulsant drugs such as lamotrigine among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

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Phenytoin Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v35i1.10539 ◽

2015 ◽

Vol 35 (1) ◽

pp. 73-75 ◽

Cited By ~ 1

Author(s):

NK Natt ◽

S Tarsem ◽

Dr Anuba ◽

S Simarjeet ◽

M Sharma ◽

...

Keyword(s):

Adverse Effect ◽

Drug Reaction ◽

Skin Rash ◽

Drug Effect ◽

Rapid Diagnosis ◽

Age Group ◽

Life Saving ◽

Paediatric Age ◽

Systemic Symptoms ◽

High Index Of Suspicion

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse effect characterized by a skin rash with visceral involvement and haematological abnormalities. This adverse drug effect is often misdiagnosed and under-reported especially in paediatric age group due to its rarity and high occurrence of skin rash in various other viral illnesses of children. We report a case of DRESS in a three months old male child. A high index of suspicion, rapid diagnosis and prompt withdrawal can be life-saving for the patient.J Nepal Paediatr Soc 2015;35(1):73-75

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A Case of Drug Reaction with Eosinophilia and Systemic Symptoms

Case Reports in Medicine ◽

10.1155/2012/705190 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sally Kellett ◽

Charles Cock

Keyword(s):

Drug Reaction ◽

Drug Therapy ◽

Skin Rash ◽

Complete Resolution ◽

Liver Enzymes ◽

Drug Discontinuation ◽

Systemic Involvement ◽

Antiretroviral Therapies ◽

Hematological Abnormalities ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) is characterized by fever, skin rash, hematological abnormalities, and systemic involvement such as hepatitis. DRESS usually presents 2–6 weeks after drug initiation. DRESS should be suspected on clinical grounds in the setting of the introduction of new drug therapy and is most commonly described after the introduction of aromatic anticonvulsants, allopurinol, or antiretroviral therapies. We describe here a case of DRESS due to phenytoin exposure with complete resolution on drug discontinuation. Our patient developed DRESS with a skin rash, lymphadenopathy, and markedly abnormal liver enzymes, 4 weeks after drug initiation following drainage of a brain abscess. He was initially diagnosed as having a recurrence of the abscess or sepsis of another origin. It is important to recognise the possibility of DRESS in this setting, as a good outcome depends on the immediate withdrawal of the offending drug. A mortality rate of up to 10% has been described in unrecognised cases.

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Sulfasalazine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) with concomitant acute chikungunya virus infection: possible role of new viral trigger

BMJ Case Reports ◽

10.1136/bcr-2021-244063 ◽

2021 ◽

Vol 14 (10) ◽

pp. e244063

Author(s):

Abheek Sil ◽

Moni Sankar Bhattacharjee ◽

Atanu Chandra ◽

Jayasri Das Pramanik

Keyword(s):

Drug Reaction ◽

Virus Infection ◽

Renal Dysfunction ◽

Skin Rash ◽

Chikungunya Virus ◽

Drug Effect ◽

Signs And Symptoms ◽

Viral Aetiology ◽

Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) is designated as a potentially lethal adverse drug effect with characteristic signs and symptoms such as skin rash, fever, leucocytosis with eosinophilia or atypical lymphocytes, lymphadenopathy and liver or renal dysfunction. In addition to most commonly implicated drug category (aromatic anticonvulsants), lamotrigine, sulfonamides, dapsone and abacavir may also induce this syndrome. We describe here a case a sulfasalazine-induced DRESS with coexisting chikungunya fever. The shared presentation of fever with rash in both conditions made it a challenging diagnosis. Sulfasalazine hypersensitivity manifesting as DRESS has rarely been reported. Furthermore, we document chikungunya virus (CV) as a possible triggering agent for DRESS. To the best of our knowledge, CV as a viral aetiology in DRESS has not been reported previously in the literature.

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